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:Fmm3000-3 1JNITED .sTATES
{Edmmy.2O!l2) ¡.: r ¡ULL :DEPARTMENT OFTIlEJNIERIOR
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" 1 !"'t~\·. \." i~t\HA·.Æt1r ,\, .BUREAU OFI..ANDMANAGEMENT
'!:;i rJ' c'~ \..".'- ASSJGNMENTDFRECORDmlEJNJ.t:ttt:::i) JNA
uflR ·lD Þ.t' 9: ,~FDRDJLANDûASDRGEOTHERMALRES01JRCES
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RE.Ct.1 ,)' \:..U ...Act:for AcquircdLands Df 194ï (30 U..5_C351-359)
. . .... .·uicl£WYOMINß". ,~nth"'m",l:StcamÅCtDfl97D (30U.s.C.1001-1ll25)
'CH£'(Er\í'I! '. nrpm+mi.nt nf:ihdntcriar.AppmpriatiQns.Act,E.i=1 Yl:3T 19.81.{42TI..s..c.D5D.8)
"Type Dr print pJainly in wand sign in ink.
. 'PART A: A55JGNMENT
A",,~ JillBElIT.Ð.EERGIISON,ìRIIST:EE OFTIIE :ROBEIITÐ.1'ERGIJBmITRIJ5T.DATEDI2l23/04
itircct .23012LA1Œ.CENJEU>RI\ffi,.BIIJ:Œ203
aty,Btate,:zIP!:ode .LAKE:FDREST,I:A~O
'FORMAP.PlUJ\ŒD
OMB NO,l004-0034
~:0dD~3L20W
lease.Serial No,
W-IB1l095
lease:E:fIcctiv.cDBte
(~ThItc)
~"J'f""'¡""'1, ]964
New .Serial ND,
'*If.mnre:tban DDC ;;""'.N'''''..cl1cCk:hcrt:::O.and 1ist:tiu: iuune(s)mnI.adda:ss(.cs) Df.all atltlitinna J~ DIl:tiu:=v.crsc :of:ihis:f'mm.or DIl2.
5Cp3DIte.attacbcd5hcct Df:papcr.
'This:n:.card:ri& ~tis:f.or. (CheclDTJe) 1ZJ Oil..an.d Gaslasc,.or D Ge.nthf'Tmall..J:asc
.1ntcœst~: (Che.ckD1'J2l)rhDih,.DS~pr~) 1ZJRccaUlT.itlc. D O~~,~DntDfJ'T"rin,,"nnJll'D1h1:r.similar
iDtacm Dl'paymcnI:s .
.:2.. 'This "~"'"t .r.DIIV.I:y.S:thc-fuUowing:inta:st:
.Land
-A tltIitinn.l5p3CC 1ID:rcvt:!ie,uJJCCdcdDo 'lint ..nhmit tlnM1TT1..m. m "&J"'=""'t. otkrjf¡¡m
:ihisËrrn;5l.lCb rlnM1TI"If':nt1: DT"'ßT"""'"'t'!I1t".shall nnly:beTM'"",",""'rlDarin.
Owned
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100% -0-
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.Lincoln County, WymnÌI!g
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lmd'to:tiu: ~0fI'F.RT]3.'HRGIJ50NTRDBTDtITED 12l23/04.
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RECEIVED 311l2DD6m 1.2:22 PM
HECEJVJNG~ 917938
.BOOK: fi18 PAGE:-426
.JEANNE WAGNER
.LINCOLN .cOUNTY ClERK, iŒMMERER,WY
TÐRBLIIIlJSEDfIIL Y -DO tIDTWRJ1EÐElDWTHlSlJNE
llNITED.5TAT£S· OF.AMERICA
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::0 cA=i.EJYn""'nf .1IJIPI'Dv.cd:for land tlf':"n-iptinn -inrli"..tf':rI Dn~
Df:ihis -furnt,
LAND LAW ~INERNAR1 -4 2006
(Title)
.(Dare) .
~ :
.Ðy
M1ðmnen e.bwe1t
(Amhnri7..lIlliIiI:cr)
. .
, .
(ÛID1imIed Dn yage.2)
FOR ASS1GNEE
(;c10;4?7
. \... ....
Part A (Continued): ADDITIONAL SPACE for Names and addresses of additional assignees in Item No, I, ifneeded, or for Land Description in Item No, 2, if
0917938 needed.
'.
. .
~:
PART B - CERTIFICATION AND REQUEST FOR APPROVAL
I, The Assignor certifies as owner if an interest in the above designated lease that he/she hereby assigns to the above assignee(s) the rights specified above,
2, Assighee certifies as follows: (a) Assignee is a citizen of the United States; an association of such citizens; a municipality; or a corporation organized under the
laws of the United States or of any State or territol)' thereof. For the assignment ofNPR-A leases, assignee is a citizen, national, or resident alien of the United
States or association of such citizens, nationals, resident aliens or private, public or municipal corporations, (b) Assignee is not considered a minor under the
laws of the State in which the lands covered by this assignment are located; (c) Assignee's chargeable interests, direct and indirect, in each public domain and
acquired lands separately in the same State, do not exceed 246,080 acres in oil and gas leases (of which up to 200,000 acres may be in oil and gas options). or
300,000 acres in leases in each leasing District in Alaska of which up to 200,000 acres may be in options, if this is an oil and gas lease issued in accordance
with the Mineral Leasing Act of 1920, or 51,200 acres in anyone State ¡fthis is a geothermal lease; (d) All parties holding an interest in the assignment are
otherwise in compliance with the regulations (43 CFR Group 3100 or 3200) and the authorizing Acts; (e) Assignee is in compliance with reclamation
requirements for all Federal oil and gas lease holdings as required by sec, 17(g) of the Mineral Leasing Act; and (t) Assignee is not in violation of sec. 41 of the
Mineral Leasing Act
3. Assignee's signature to this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restrictions pertaining to the leáse described
herein.
For geothermal assignments, an overriding roy¡lIty may not be less than one-fourth (1/4) of one percent of the value of output, nor greater than 50 percent of the rate of
royalty due to the United States when this assignment is added to all previously ,created overriding royalties (43 CFR 3241),
I certitÿ that the statements made herein by me are true, complete, and correct to the best of my knowledge and belief and are made in good faith.
Executed this
14th
day of
December
20~
Executed this
14th
day of
December
20~
Name of Assignor as shown on current lease Robert B, Ferguson
- ¡miit)
Assignee
or
Attorney-in-fact
.J.
Assignor
or
Attorney-in-fact
CA
(Slate)
92630
(Zip Code)
Public reporting burden for this form is estimated to average 30 minutes per response including the time for reviewing instructions, gathering and maintaining data, and
completing and reviewing the form. Direct comD)ents regarding the burden estimate or any other aspect of this form to U.S. Deparbnent of the Interior, Bureau of Land
Management (1004-0034), BureaQ",!nfoqpatton'Còltection Clearance Officer, (WO-630), 1849 C Street, N,W" Mail Stop 401 LS, Washington, D,C, 20240,
Title 18 U.S,C. Sec. 1001 makes it a crime for any ~rson knowin \ly and willfully to make to any Deparbnent or agency of the United States any false, fictitious or fraudulent
statements or representations as to any matter WIthin its jurisdiction,. , . .
RECEIVED
MAR 2 0 2006
(Form 3000-3, page 2)
._~_._._. ..--.------.--- ---------------
000428
0317338
W-0311095
~~.
ACKNOWLEDGMENT
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STATE OF CALlFÖRNIA'" "" "f,; . i'" .~':'
'}ss. .
COUNTY OF ORANG'Ë"~"\'¡ n;",,'>!'?' \i'~P!t ¡."/\ Ii' ,;"n:"'1 to: "<11
I.'
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f
On December 14. 2005, before me, the undersigned authority, personally appeared ROBERT
B. FERGUSON, personally known to me (or proved to me on the basis of satisfactory evidence)
to be the person whose name is subscribed to the within instrument and acknowledged to me
that he executed the same in his authorized capacity, and that by his signature on the instrument
the person or the entity upon behalf of which the person acted, executed the instrument.
\'
~ITNESS my hand and official seal.
Signature ~"\"\\ ~~ö" r:
.l ~~.-:. DOROTHY A, METZGER ~
- . Comm,#1448772
1/).. . NOTARY PUBLIC· CALIFORNIA ~
~ Olonge Counly ...
~. . My Comm, Expires Noy, 1.2007 t
J -
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